Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

Quarpong, Wilhemina; Card, Timothy R.; West, Joe; Solaymani‐Dodaran, Masoud; Logan, Richard F.; Grainge, Matthew J.

doi:10.1177/2050640618814662

Cited by 18 publications

(31 citation statements)

References 22 publications

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“…Altogether, the rise was lower than previously reported (Table 4). Mortality from gastrointestinal cancers was not increased, which concurs with the results from the UK (42). Interestingly, despite the decreased incidence of breast cancer in celiac disease (13,29,43), mortality was not significantly reduced.…”

Section: Discussionsupporting

confidence: 86%

Overall and Cause-Specific Mortality in Adult Celiac Disease and Dermatitis Herpetiformis Diagnosed in the 21st Century

et al. 2020

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Objectives: We assessed whether celiac disease-associated mortality is increased among patients diagnosed in the 21 st century given recent improvements in diagnostic and treatment facilities.Methods: Biopsy-proven celiac disease (Marsh III) and dermatitis herpetiformis patients aged 20-79 years (median 50 years) diagnosed 2005 -2014 (n=12,803) were identified from the national dietary grant registry. Dates and causes of death were obtained from Statistics Finland. Overall mortality and causes of death were compared to reference individuals (n=38,384) matched for age, sex, and area of residence (at the time of celiac disease diagnosis) selected from the Population Information System.Results: During a mean follow-up of 7.7 years (SD ± 3.0 years), 884 (6.9%) and 2,613 (6.8%) deaths occurred among the celiac cohort and reference group respectively. Overall mortality (hazard ratio (HR) 1.01, 95% confidence intervals (CI) 0.94-1.09), mortality from all malignancies (HR 1.11, 95% CI 0.96-1.27), gastrointestinal tract malignancies (HR 1.21, 95% CI 0.56-1.71) or cardiovascular diseases (HR 0.91, 95% CI 0.77-1.07) were not increased among celiac patients.Overall, mortality from lymphoproliferative diseases (HR 2.36, 95% CI 1.65-3.39) and nonmalignant digestive diseases (HR 2.19,) was increased, but HRs decreased after exclusion of the first two years of follow-up (HR 1.71, 95% CI 1.10-2.66 and HR 1.75, 95% CI 1.01-3.05 respectively). Conclusions:The overall mortality in adult celiac disease diagnosed 2005-2014 was not increased.Mortality from lymphoproliferative diseases was increased but lower than previously reported.

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Section: Discussionsupporting

confidence: 86%

Overall and Cause-Specific Mortality in Adult Celiac Disease and Dermatitis Herpetiformis Diagnosed in the 21st Century

et al. 2020

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“…Another analysis of mortality risk in celiac disease, set in the Lothian region of Scotland and including 237 deaths, found that beyond 25 years, mortality was no longer increased among those diagnosed with celiac disease as adults (standardized mortality ratio, 0.97 [95% CI 0.74-1.24]), but was persistently increased among those diagnosed in childhood (standardized mortality ratio, 2.24 [95% CI, 1.45-3.30]). 15 In contrast, in this study, mortality risk was present across age strata, including children. This mortality risk diminished after diagnosis and institution of the gluten-free diet but remained modestly elevated in the long term.…”

Section: Discussioncontrasting

confidence: 66%

“…2,12 Moreover, other studies have shown no increased overall mortality risk, 13 a risk that is declining in more recent years, 14 or a long-term risk that is restricted to those with a diagnosis in childhood. 15 It is uncertain whether patients diagnosed in this era have a similar mortality increase, as higher diagnosis rates may result in a less severe clinical phenotype.…”

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confidence: 99%

Association Between Celiac Disease and Mortality Risk in a Swedish Population

Lebwohl

Green

Söderling

et al. 2020

JAMA

116

113

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IMPORTANCE Celiac disease may be associated with a modest but persistent increased long-term mortality risk. It is uncertain whether this risk has changed in the era of wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food. OBJECTIVE To evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden. DESIGN, SETTING, AND PARTICIPANTS All individuals in Sweden with celiac disease diagnosed between 1969 and 2017 were identified through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort. Participants (n = 49 829) were observed starting on the day of the biopsy. The final date of follow-up was December 31, 2017. EXPOSURES Celiac disease was defined by the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden's 28 pathology departments. Each individual was matched with as many as 5 control participants in the general population by age, sex, county, and calendar period. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality. Patients with celiac disease were compared with controls using stratified Cox proportional modeling, stratifying by year of diagnosis. RESULTS There were 49 829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n = 6596) died. Compared with controls (n = 246 426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, 1.2 per 1000 person-years; hazard ratio [HR], 1.21 [95% CI, 1.17-1.25]). The relative increase in mortality risk was present in all age groups and was greatest in those diagnosed in the age range of 18 to 39 years (1.9 vs 1.1 per 1000 person-years; HR, 1.69 [95% CI, 1.47-1.94]; P values for heterogeneity comparing 18-39 years with 40-59 years and with Ն60 years were both <.001). Individuals with celiac disease were at increased risk of death from cardiovascular disease (3.5 vs 3.4 per 1000 person-years; HR, 1.08 [95% CI, 1.02-1.13]), cancer (2.7 vs 2.2 per 1000 person-years; HR, 1.29 [95% CI, 1.22-1.36]), and respiratory disease (0.6 vs 0.5 per 1000 person-years; HR, 1.21 [95% CI, 1.08-1.37]). When compared with controls, the overall mortality risk was greatest in the first year after diagnosis (15.3 vs 6.5 per 1000 person-years; HR, 2.34 [95% CI, 2.14-2.55]) but persisted beyond 10 years after diagnosis (10.5 vs 10.1 per 1000 person-years; HR, 1.15 [95% CI, 1.10-1.20]). The mortality risk was likewise present for patients diagnosed during the years 2010-2017 (7.5 vs 5.5 per 1000 person-years; HR, 1.35 [95% CI, 1.21-1.51]). CONCLUSIONS AND RELEVANCE In a Swedish population studied between 1969 and 2017, a diagnosis of celiac disease compared with the general population was associated with a smal...

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“…Coeliac disease can impact many aspects of quality of life, including emotional health, and daily and leisure activities ( 9 ) . Furthermore, there is a small increased risk of malignancy and mortality compared to the general population ( 10,11 ) , and an increased likelihood of developing other autoimmune diseases ( 12 ) . Hence, it is important that people can access health services to diagnose and manage their condition.…”

Section: Introductionmentioning

confidence: 99%

Healthcare experiences and quality of life of adults with coeliac disease: a cross‐sectional study

Crocker

Jenkinson

Peters

2020

J Human Nutrition Diet

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Background Coeliac disease affects many aspects of quality of life and treatment can be burdensome. Access to healthcare services is necessary for the diagnosis and management of coeliac disease. The present study aimed to investigate the healthcare experiences of adults with coeliac disease and explore the relationship between experiences and quality of life. Methods A cross‐sectional postal survey was sent to 800 members of Coeliac UK and contained questions about diagnosis, dietary advice, follow‐up appointments, prescriptions, knowledge and information provision, and quality of life [Coeliac Disease Assessment Questionnaire (CDAQ)]. Descriptive statistics were calculated. A total problem score summarised the number of problems experienced with healthcare services. Multiple linear regression analyses were conducted to investigate experiential and demographic factors associated with quality of life. Results An average of 5.5 problems with healthcare services was reported, with females reporting significantly more problems than males (6.5 versus 5.0, P = 0.003). The total problem score was significantly related to the CDAQ overall index score and all CDAQ dimension scores (stigma, dietary burden, symptoms, social isolation, and worries and concerns) (P < 0.001). The analyses highlighted four key areas of healthcare experiences that were significantly related to quality of life: information provision, general practioners’ knowledge, communication with health professionals and access to prescriptions. Conclusions Poorer experiences of healthcare services in coeliac disease are related to worse quality of life. Improving services in the four key areas identified may help adults with coeliac disease to achieve a better quality of life.

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Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

Cited by 18 publications

References 22 publications

Overall and Cause-Specific Mortality in Adult Celiac Disease and Dermatitis Herpetiformis Diagnosed in the 21st Century

Overall and Cause-Specific Mortality in Adult Celiac Disease and Dermatitis Herpetiformis Diagnosed in the 21st Century

Association Between Celiac Disease and Mortality Risk in a Swedish Population

Healthcare experiences and quality of life of adults with coeliac disease: a cross‐sectional study

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